Innovative management of secondary lymphedema with complex decongestive therapy and targeted strengthening exercises: a case report

This case report presents a 70-year-old male with secondary lymphedema of the left lower limb, a condition arising post-radical prostatectomy and pelvic lymphadenectomy for prostate cancer. This case uniquely integrates complex decongestive therapy (CDT) with targeted muscle strengthening to address both chronic edema and associated functional impairments, providing objective evidence of the benefits through advanced diagnostics such as isokinetic testing. The patient presented with persistent swelling, reduced joint mobility, and muscle weakness in the affected limb. Key clinical findings included a positive pitting test, restricted dorsiflexion (0°) and knee flexion (110°), and significant volume discrepancies between limbs. The primary diagnosis was secondary lymphedema. Treatment involved 10 CDT sessions combined with a structured strengthening program and daily use of compression garments. Outcomes included a 7% reduction in limb circumference, 35-45% increases in peak torque for key muscle groups, improved range of motion, and enhanced quality of life as measured by SF-36 and Lymphedema Life Impact Scale scores. This case highlights the importance of an integrative approach for lymphedema management, addressing both physiological and functional challenges. The take-away lesson is that combining CDT with strengthening exercises can significantly improve outcomes, offering a model for personalized care in early-stage lymphedema.